Medicare, the nation’s largest government health insurance plan, covers 97% of Americans 65 years of age and older. Most enrollees apply for Medicare around their 65th birthday. However, some individuals qualify earlier due to a certain health condition or disability.
About 16% of Medicare enrollees are younger than 65 years of age. In 1973, the program expanded coverage to individuals who receive Social Security Disability Insurance (SSDI) benefits.
The Social Security Administration uses a different definition of disability than other government programs. SSDI recipients are unable to earn an adequate income because of a medically diagnosed impairment that:
- Is expected to result in death,
- Has lasted for a continuous 12 months, or
- Is expected to last for a continuous 12 months.
Recipients may qualify for both SSDI payments and Medicare benefits for any of the reasons below:
- Mental or physical disabilities
- Mental disorders
- Musculoskeletal system diseases
SSDI recipients can start their Medicare enrollment after receiving 24 months of payments. However, it’ll take another five months before benefits begin. This means that new SSDI beneficiaries could get Medicare coverage in 29 months.
Not all younger applicants are required to wait for their coverage to kick in. Individuals with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) could start receiving benefits once they are diagnosed by a medical professional.
However, ESRD patients must also qualify for retirement or disability benefits to qualify for Medicare. Generally, they can qualify if they have enough work credits or are the spouse or dependent of someone who meets the requirements.
SSDI recipients do not need to apply for Medicare, since the SSA automatically enrolls them on the 25th payment month. The SSA also automatically enrolls recipients with ALS the first month they are eligible to receive payments.
The Medicare Part A premium for enrollees younger than 65 years of age depends on their work credits, medical diagnosis, or benefits entitlement. Young enrollees may get premium-free Part A if they meet the following criteria:
- They have been diagnosed with ALS
- They are on kidney dialysis
- They are a kidney transplant patient
- They have received Social Security or Railroad Retirement Board disability benefits for at least 24 months
Even if enrollees are eligible for premium-free Part A coverage, they’ll still typically need to pay monthly for Medicare Part B and Part D plans.
Individuals who the SSA does not automatically enroll in the program should apply for Medicare when they first meet the qualifications. Enrollees could be subject to higher premiums if they enroll late and do not have adequate insurance.
Likewise, enrollees can only change plans during certain times of the year. Continue to the next slide to learn more about these enrollment periods and penalties.